Assessment or evaluation of student performance in a problem-based learning (PBL) curriculum is difficult to plan or implement.Many medical schools which have switched to a PBL learning format usually use traditional evaluation methods based on factual recalls, which usually has a negative influence on the learning style of the students, thereby reducing the impact of PBL. The purpose of this review is to discuss the various evaluation methods with a particular focus on methods applicable to PBL, so that we can make intelligent use of these methods in our PBL curriculum. In combination with evaluation methods adopted at McMaster University, the article makes an elaboration about them.

Objective To describe CT and MRI imaging findings of retinal hamartomas with tuberous sclerosis and evaluate their clinical value. Design Retrospective case series. Participants 7 patients of tuberous sclerosis complex (TSC) who have ocular lesions found with CT and MRI examination. Methods 7 patients with tuberous sclerosis were diagnosed by clinical data and head CT. The size, morphology, density and enhancing situation of the retinal lesions were observed with CT and MR.I, as while as with direct or indi-rect fundoscopy. Main Outcome Measures CT and MRI features of ocular lesions. Results 7 cases displayed intraeranial calcification and/or non-calcified tubercles, situating in subendyrna (7 cases, accounting for 100%) by head CT. Orbital CT and MRI showed 4 cases (57.1%) of flat retinal hamartomas 3 cases (42.9%) 9f retinal lobular and nodular hamartomas, 2 cases(28.6%) scattered calcification patches in hamartoma, and 2 cases (28.6%) of nanophthalmos. The lesions displayed unenhancement on contrast-enhanced MR images in 7 cases(100%) . There was 1 case (14.3%) of progressive retinal astrocytic hamartoma. Conclusion The examination of CT and MRI may find the bigger retinal hamartomas, which can play a very important role at the diagnosis with the help of whole brain examination. For progressive retinal nstrocytic hamartoma,systemic evaluation with CT and MRI can provide evidence for choosing appropriate thera-pies. (Ophthalmol CHN, 2009, 18: 257-260)

Excess energy has become a main reason for increasingly serious human health hazards. Excess energy, mainly ectopically deposits in the liver, pancreas and other organs in the form of triglycerides, and produces chronic oxidative, nitrosative stress (ONS) , and fat toxicity, resulting in insulin resistance and impaired insulin secretion, and further impaired glucose regulation (Pidan). By combining Chinese medical pathogeneses and symptoms analyses, authors found this process has features of Gan disease transferring to Pi. Based on a number of related guidelines and clinical practice, we demonstrated treating sputum and stasis by the same method was one treatment method for intervening liver disease transferring to spleen in metabolic diseases. This idea helps to organic integrating prevention and treatment of major metabolic diseases including non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus, which can improve clinical effectiveness and efficiency of Chinese medicine.
Diabetes Mellitus, Type 2 ; therapy ; Early Intervention (Education) ; Humans ; Insulin ; Insulin Resistance ; Metabolic Diseases ; Non-alcoholic Fatty Liver Disease ; Risk Factors ; Triglycerides

Stenotrophomonas maltophilia is among eight strain of broad resistance to antibacterial. It has been pay attention to global students, and is very difficulty in clinic treatment. Infection of Stenotrophomonas maltophilia is more familiar in ICU. Its test rate is 13.45%(62/461) in the study .The resistance character: IPM﹑CZO﹑CRO﹑AMP and MNO is highest(resistive rate 100%). ATM、GEN 、 KAN 、MEM 、CTX and PIP is much high(≧86.5%), LVX﹑GAT and FEP is high (=50%).Conclusion: Stenotrophomonas maltophilia should be monitored in the hospital. Used of antibacterial must be rational. Severe disinfection and isolation should been put in practice to the infected patients. CSL is very active antibacterial (active rate 90.6%) against Stenotrophomonas maltophilia in the study, and ought be selected headmost in treated its infection.

Animals ; Apoptosis ; Caspase 3 ; metabolism ; Male ; Myocardium ; pathology ; Rats ; Rats, Wistar ; Time Factors ; Wounds and Injuries ; physiopathology

AIM: To systemically evaluate the clinical efficacy and safety of intraocular implants for vitreous retinal surgery.METHODS: We performed a comprehensive search for studies reporting vitreous surgery with intraocular implants randomized controlled and a retrospective controlled clinical trials from China Hownet ( CNKI ), Wanfang database, and VIP literature database. Studies obtained from those database were filtered according to the criteria, and data were retrieved from eligible studies for further analysis. Then we performed a meta-analysis to evaluate the efficacy and safety of intraocular implants using comprehensive Meta - analysis software version 2 (Biostat, Englewood, NJ).
RESULTS: In total 36 studies were recruited for our Meta - analysis, including 5 092 cases. Meta analysis showed: 1) regarding the efficacy of repairing the retinal detachment, silicone oil was a better intraocular implants than C3 F8(OR= 1. 76; 95% CI: 1. 19-2. 60, P = 0. 0047) and SF6( OR = 4. 68; 95% CI: 1. 48 - 14. 81, P = 0. 0087); 2) regarding the risk of postoperative cataract, silicone oil showed significant higher risk than BBS (OR = 3. 24; 95%CI: 2. 10-4. 99, P= 1. 09 e-7), and C3 F8(OR= 3. 03; 95% CI:1. 50 - 6. 10, P = 0. 0019 ); 3 ) regarding the risk of postoperative intraocular pressure, silicone oil showed significant higher risk than BBS (OR= 6. 74; 95% CI: 3. 38-13. 41, P= 5. 67 e-08), and C3 F8 also showed a higher risk than BBS (OR= 4. 79; 95% CI: 2. 37-9. 68, P = 1. 29 e-05). In addition, silicone oil showed significant lower risk as compared with heavy silicone oil (OR= 0. 16; 95% CI: 0. 08-0. 53, P= 0. 0026).
CONCLUSION: The intraocular implants for the treatment of retinal detachment in vitreous retinal surgery are mainly divided into two major categories, liquid and gas implants. The silicone oil, a major liquid implant, shows higher efficacy in terms of treating retinal detachment than the gas implants. However, the silicone oil is associated with a higher risk of postoperative cataract and intraocular pressure as compared with gas implants.

Adult ; Antimony ; adverse effects ; Dust ; Female ; Humans ; Male ; Middle Aged ; Occupational Exposure ; adverse effects ; Young Adult

Objective To evaluate the effect of transcatheter arterial chemoembolization (TACE) and delayed surgery for infant hepatoblastoma.Methods TACE was performed with the initial digital subtractive angiography (DSA) under general anesthesia 1-3 times in 8 infants with huge hepatoblastoma, whose age was 2 to 12 months. DSA was done via arterials in hepatoblastoma each time before chemoembolization. The arterials were perfused with chemodrugs and suspensions in ultrasome iodized oil , and were blocked with spring rings. DSA findings indicated that the tumor shrank without new tumorous arterials after 1 month in 6 cases, and 4 of them showed no tumorous staining, and the delayed surgery was performed successfully 1 week later in 6 infants. One boy underwent systemic chemotherapy alone during 6 months after 3 times of TACE. Results TACE therapy did not encounter any major technical problem or toxic reaction caused by chemotherapy. The following DSA test 4 weeks later did not detect any new tumorous vessels in 6 cases. Six children received TACE and surgery had been followed-up with no tumor recurrence for months averagely. The boy underwent TACE and venous chemotherapy for 6 months , without surgery , had been followed-up for 48 months until the present report. CT, AFP and DSA did not show any hints of tumor recurrence. Six cases receiving 3 times TACE combined with surgery survived without tumor recurrence. Conclusions TACE is a very effective, safe and helpful therapy for hepatoblastoma, which stressed the repeated use of spring ring to block tumor vessels lastingly if necessary. If surgery is required, DSA test is needed beforehand to detect new tumorous vessels or neoplasm. If there is any , TACE is repeated. TACE combined with surgery may provide an additional promising choice in the treatment of hepatoblastoma, and repeated TACE alone may cure hepatoblastoma in infants.

OBJECTIVETo investigate the effect of Syk on the VEGF-C expression in breast cancer.

METHODSImmunohistochemical EnVision method was used to detect the protein expression of Syk, NFκB and VEGF-C in breast carcinoma; and the relationship between protein expression of Syk, NFκB, VEGF-C and lymph node metastasis was analysed. MDA-MB-231 cells were transfected with pcDNA3.1(-)-Syk, and the effect of Syk gene on the VEGF-C and NFκB expression was determined.

RESULTSIn the lymph node metastatic group, a lower expression rate of Syk and higher expression rate of VEGF-C and NFκB were detected as compared to the non-metastatic group. The expression of Syk was negatively associated with NFκB (r = -0.448, P = 0.002) and VEGF-C (r = -0.620, P = 0.000) expression, and VEGF-C was associated with the nuclear expression of NFκB (r = 0.310, P = 0.036). Compared with the non-transfected cells, the pcDNA3.1(-)-Syk transfected MDA-MB-231 cells showed significantly lower transcriptional level of VEGF-C mRNA, expression level of VEGF-C protein and NFκB activity (P < 0.05).

CONCLUSIONSSyk may play an important role in the lymph node metastasis of breast cancer. It may down-regulate the expression of VEGF-C by inhibiting the activity of NFκB, which thus suppresses lymph node metastasis of breast cancer.

Adult ; Aged ; Breast Neoplasms ; genetics ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; genetics ; metabolism ; pathology ; Carcinoma, Lobular ; genetics ; metabolism ; pathology ; Carcinoma, Medullary ; genetics ; metabolism ; pathology ; Cell Line, Tumor ; Female ; Genetic Vectors ; Humans ; Intracellular Signaling Peptides and Proteins ; genetics ; metabolism ; physiology ; Lymphatic Metastasis ; Middle Aged ; NF-kappa B ; metabolism ; Plasmids ; Protein-Tyrosine Kinases ; genetics ; metabolism ; physiology ; RNA, Messenger ; metabolism ; Syk Kinase ; Transfection ; Vascular Endothelial Growth Factor C ; genetics ; metabolism

Objective To summarize the features of esophageal hiatus hernia (EHH) on contrast-enhanced ultrasound (CEUS) and investigate the diagnostic value of CEUS in EHH.Methods A retrospective analysis of 88 EHH patients and 50 healthy controls was conducted with focus on their findings on CEUS.Results The structures of the cardiac and abdominal esophagus were clear in 50 healthy controls,and the esophageal hiatus diameters were (1.96±0.39) cm.In contrast,the cardiac and abdominal esophagus in EHH patients were unable to be identified in subdiaphragm region.The esophageal hiatus was wider with a diameter of (3.24±0.76) cm.The difference was statistically significant(t=2.36,P＜0.05).The hernia sacs were found in 78 EHH patients at rest.And the hernia sacs were present on the diaphragm in 10 EHH patients after pressure.The maximum diameter of hernia sac was 7.6 cm.The size of hernia sac may change with abdominal pressure.In sliding EHH patients,the sac wall was found to slide up and down the diaphragm.A mass was found on the wall in 2 patients.The B ring was present in 76 patients.For healthy controls in supine position,contrast-enhanced ultrasound showed that the gastric bottom and diaphragm were at dependent or horizontal position.The gastric bottom and diaphragm was upward in 73 patients.Conclusions The EHH has characteristic appearance on CEUS.It is easy to detect and diagnose EHH with CEUS,which has a diagnostic value in detection of space-occupying lesions in hernia sac.CEUS can be used for EHH screening.